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Acute Care > Integumentary > Flashcards

Integumentary Flashcards

1
Q

What are the layers of the skin?

A

Epidermis

Dermis

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2
Q

What is the function of the epidermis?

A
  • temperature regulation
  • moisture regulation
  • sensation
  • protection from infection/disease
  • cosmesis
  • interaction with the environment
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3
Q

What are the 5 layers of the epidermis?

A

“Come, Let’s Get a Sun Burn”

  • Stratum Corneum
  • Stratum Lucidium
  • Stratum Granulosum
  • Stratum Spinosum
  • Stratum Basale
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4
Q

What are the other important epidermal cells?

A
  • melanocytes
  • merkel cells
  • langerhans cells
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5
Q

What is the function of melanocytes?

A
  • produce melanin to give skin its pigment and protect from harmful UV rays
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6
Q

What is the function of Merkel cells?

A
  • specialized mechanoreceptors to provide information about light touch
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7
Q

What is the function of Langerhans cells?

A
  • located in the deeper epidermal layers

- help fight infection by attacking and engulfing foreign material

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8
Q

What is the function of the dermis?

A
  • 2 layers that are highly vascularized
  • fibroblasts in this layer produce collagen and elastin
  • nerve endings located here
  • contains support structures: hair follicles, sudoriferous glands, sebaceous glands, vasculature, and lymphatics
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9
Q

What are the risk factors that increase the risk of wounds and impaired wound healing?

A
  • medications (anticoagulants, steroids, immunosuppressants)
  • diabetes (chronic blood sugar > 250)
  • tobacco use
  • poor nutritional status (especially protein –> look at albumin & pre-albumin)
  • CV comorbidities (arterial/venous disease, heart failure)
  • reactive/autoimmune processes
  • reduced mobility
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10
Q

Define a decubitus ulcer

A
  • a lesion caused by unrelieved pressure resulting in damage to the underlying tissues
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11
Q

Where do decubitus ulcers typically occur?

A

over bony prominences

  • sacrum
  • heels
  • ischial tuberosity
  • greater trochanter
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12
Q

What is the pathogenesis of decubitus ulcers?

A

pressure –> ischemia –> tissue necrosis

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13
Q

Describe a stage 1 decubitus ulcer

A
  • non-blanchable erythema of intact skin
  • lesion of skin ulceration
  • discoloration of skin in individuals with darker skin
  • warmth
  • edema
  • induration
  • hardness
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14
Q

Describe a stage 2 decubitus ulcer

A
  • partial-thickness skin loss involving epidermis, dermis or both
  • superficial and presents clinically as an abrasion
  • blister
  • shallow center
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15
Q

Describe a stage 3 decubitus ulcer

A
  • full-thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia
  • presents clinically as a deep crater with or without undermining of adjacent tissue
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16
Q

Describe a stage 4 decubitus ulcer

A
  • full-thickness skin loss with extensive destruction
  • tissue necrosis
  • damage to muscle, bone, or support structures
  • undermining and sinus tracts may also be associated
  • assume the patient has osteomyelitis
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17
Q

What colors may a decubitus ulcer present with?

A
  • red
  • brown
  • black
  • yellow
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18
Q

What should be noted about decubitus ulcers

A
  • can have a localized, self-limiting infection
  • foul smelling exudate may be present
  • wound may be painful unless pt has decreased sensation
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19
Q

How is a decubitus ulcer prevented?

A
  • bed positioning (change ever two hours)
  • WC cushioning and unweighting/pressure relief exercises
  • if the patient is unable to perform pressure relief, a tilt in space WC may be appropriate
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20
Q

Name the stages of burns

A
  • first degree (superficial burns)
  • second degree (partial thickness burns)
  • third degree (full thickness burns)
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21
Q

Describe a first degree burn

A
  • only epidermis affected
  • skin is red, dry, and painful
  • no blisters
  • usually heals within 1 week
  • no long-term damage
    Ex: sunburn, burn from curling iron
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22
Q

Describe a second degree burn

A
  • epidermis and part of dermis damaged
  • skin is red, blistered, swollen, and painful
  • skin may appear wet or shiny
  • skin may be white/irregularly discolored
  • dressing changes may be painful
  • may heal in 3 weeks (or require more advanced management)
  • can be classified as superficial or deep
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23
Q

Describe a third degree burn

A
  • epidermis and entire dermis are damaged
  • dry, leathery skin
  • brown, yellow, or black skin
  • no pain due to burned nerve endings
  • requires extensive medical management for healing
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24
Q

What is the Rule of 9’s used for?

A

to calculate the total surface area for a burn injury

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25
Q

For the Rule of 9’s:

What percent are the head, chest, abdomen, upper back, and lower back?

A

9% each

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26
Q

For the Rule of 9’s:

What percent is a single arm?

A

9%

4.5% for the front and 4.5% for the back

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27
Q

For the Rule of 9’s:

What percent is a single leg?

A

18%

9% for the front and 9% for the back

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28
Q

For the Rule of 9’s:

What percent are the genitals?

A

1%

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29
Q

What medical issues should be of concern following a burn injury?

A
  • pain management
  • electrolyte/fluid management
  • nutrition
  • wound care (antimicrobials, skin substitutes)
  • infection prevention
  • pulmonary status
  • psychological adjustment support
  • surgery and skin graft management
30
Q

What PT interventions are used to address burn injuries?

A
  • contracture management
  • positioning
  • splinting
  • scar management
  • prevention of wound infection
  • improve mobility and CV function
31
Q

Why is contracture management so important following a burn injury?

A
  • a healing scar is at a high risk for contracture development which can significantly impact function
32
Q

When is positioning key? What should be considered?

A

For acute injury and managing post-surgical edema

- consider use of pillows, towels, wash cloths

33
Q

When is splinting required? What are the goals?

A
  • required with increased burn depth
  • collaboration with OT needed
  • goals: to promote neutral alignment for optimal function
34
Q

What is the preferred position of the neck for positioning?

A

extension, no rotation

35
Q

What is the preferred position of the shoulder for positioning?

A

abduction to 90
ER
horizontal flexion to 10

36
Q

What is the preferred position of the elbow and forearm for positioning?

A

extension with supination

37
Q

What is the preferred position of the wrist for positioning?

A

neutral or slight extension

38
Q

What is the preferred position of the hand for positioning?

A

Dorsal Burn:
- functional position
Palmar Burn:
- finger and thumb extension

39
Q

What is the preferred position of the trunk for positioning?

A

straight postural alignment

40
Q

What is the preferred position of the hip for positioning?

A

neutral extension/flexion
neutral rotation
slight abduction

41
Q

What is the preferred position of the knee for positioning?

A

extension

42
Q

What is the preferred position of the ankle for positioning?

A

neutral or slight DF
no inversion
neutral toe extension/flexion

43
Q

Which types of burns are more likely to have significant scars?

A

the severity of the burn and the person’s ethnicity are related to the amount of scar formation

44
Q

What are 2 types of scars following a burn injury?

A
  • Hypertrophic scars

- Keloid scars

45
Q

Describe hypertrophic scars

A
  • raised above the normal skin surface

- occur at the time of injury

46
Q

Describe keloid scars

A
  • grow beyond the area of the original injury

- grow months/years after injury

47
Q

What is scarring following a burn injury related to?

A
  • growth of collagen fibers in disorganized manner

- lack of balance between deposition and breakdown

48
Q

How are compression garments used for scar management?

A
  • customized to patient
  • frequent re-assessment
  • worn for 6-12 months
  • can be used to protect tissues when grafting is delayed
  • worn for 23hrs/day
49
Q

What are the goals for compression garments?

A
  • scar maturation
  • protection of healing skin
  • shrink the scar
50
Q

What is the typical compression for a garment worn for scar management?

A

24-30mmHg

51
Q

What are other scar management techniques?

A
  • silicone sheets
  • scar massage
  • injections
  • surgery
52
Q

Describe how silicone sheets are used in scar management?

A
  • applied under compression garments or where garments cannot conform to skin
  • comfortable and do not restrict movement
  • worn for 6-12 months, >20hrs/day
  • some studies show reduction in scars with prolonged application/wear time
53
Q

How is scar massage done?

A
  • perpendicular to collagen fibers

- moisturizing with appropriate lotions

54
Q

How are injections used for scar management?

A
  • corticosteroids are injected into the scar 3-4 times every month
55
Q

How is surgery used for scar management?

A
  • used as a last resort, only if the scars severely impact function
  • creates a new wound so that a cycle of healing begins again
56
Q

What are the different types of burns?

A
  • thermal
  • electrical
  • chemical
  • UV and ionizing radiation
57
Q

What are general wound principles?

A
  • pressure ulcer prevention
  • off-loading
  • Braden scale (predicts pressure sore risk)
58
Q

What are the components of a nutritional assessment?

A
  • nutrition
  • hydration
  • education
59
Q

What are the components of wound preparation?

A
  • infection control
  • debridement
  • cleansing
60
Q

What are the components of a wound environment?

A
  • moist environment
  • protection from heat and cold
  • packing
  • removing excess drainage
61
Q

What is assessed during wound care?

A
  • location of wound
  • size of wound (depth, tunneling, undermining)
  • tissue types
  • exudate
  • periwound skin
  • abscess
62
Q

What should be kept in mind during debridement?

A
  • infection/inflammation control
  • moisture balance
  • edge/environment
  • support with products, services, and education
63
Q

What are the types of debridement?

A
  • mechanical debridement
  • autolytic debridement
  • enzymatic debridement
  • surgical debridement
64
Q

What are the characteristics of the ideal dressing?

A
  • manages exudate appropriately
  • allows for gaseous exchange
  • impermeable to bacteria, minimizes contamination
  • free from particulate or toxic contamination
  • non-traumatic or minimally painful on removal
65
Q

What are some general desired attributes when selecting dressings?

A
  • provides environment for healing
  • user-friendly
  • cost-effective
  • compatible with support needs
  • minimize need for secondary dressing when able
  • use in infected wounds
  • remain in place for expected time frame
66
Q

What are the different types of dressings?

A
  • transparent film
  • hydrogels
  • foam
  • calcium alginates
  • hydrocolloids
  • hydrofibers
  • medical grade honey
  • collagenase
  • silver sulfadiazine
  • skin substitutes
67
Q

How is ABI used during assessment of diabetic foot ulcers?

A

ABI = ankle systolic pressure/brachial systolic pressure

- used for a vascular exam of the pt

68
Q

What are the values for ABI?

A 
Normal: 0.9 - 1.3
Mild: 0.7 - 0.89
Moderate: 0.4 - 0.69
Severe: <0.4
Non-compressible vessels: >1.30
69
Q

What does the Diabetic Foot Risk Classification tell us?

A

provides the percent of risk of foot ulcer and amputation based on medical status

70
Q

What does the Wagner Ulcer Classification System tell us?

A

assesses ulcer depth and presence of gangrene and loss of perfusion
- does not fully address infection and ischemia

71
Q

What does the University of Texas Wound Classification System tell us

A

assesses ulcer depth, presence of infection, presence of signs of LE ischemia

  • describes the presence of infection and ischemia better than Wagner
  • may help in predicting the outcome of the diabetic ulcer

Acute Care (11 decks)

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